COLUMBUS, OhioA large research study has validated a short questionnaire for cancer patients designed to assess nutritional risk and to establish a triage system for intervention, Faith Ottery, MD, PhD, president of Ottery & Associates, Oncology Care Consultants, said at the Fourth Annual Congress of the Society for Nutritional Oncology Adjuvant Therapy (NOAT). Dr. Ottery founded NOAT in 1993.
The study, sponsored by NOAT, showed the effectiveness of the Patient-Generated Subjective Global Assessment (PG-SGA) as an inexpensive, easy-to-use tool for nutritional assessment. The volunteer research study, begun in 1996, included nearly 2,000 patients from 33 sites. Patients with various cancers, as well as patients with chronic renal failure, were included.
The one-page PG-SGA includes questions for the patient regarding weight change, food intake, participation in activities of daily living, and symptoms that have prevented the patient from eating well. The clinician scores each section of the questionnaire and adds those scores together.
The scores are used to evaluate nutritional risk and to assign the patient to one of four intervention pathways: no intervention; patient education and, if necessary, symptom management; aggressive oral nutrition; and enteral/parenteral nutrition triage with an interdisciplinary team.
Although 60% of patients who completed the PG-SGA reported no problems eating, 55% of this group checked off one or more nutrition impact symptoms on the questionnaire, including mouth sores, constipation, pain, and nausea. Notably, both patients and clinicians rarely think of such symptoms as affecting nutrition, Dr. Ottery said. The PG-SGA scoring system, however, considers the presence of these symptoms in its evaluation.
Overall, the majority of nurses and dietitians who participated in the study agreed with the interventions recommended to patients based on their PG-SGA scores. One area of substantial disagreement, however, concerned patients who received high scores.
A high score indicated the need for aggressive nutritional intervention. Thirty-two percent of clinicians disagreed with this triage score and noted that they believed high-scoring patients need better symptom management rather than nutritional intervention, Dr. Ottery said. As a result, additional emphasis on symptom management was added to the intervention pathways.
The PG-SGA is widely used by members of the Oncology Nursing Society and has been accepted as the standard for oncology patients by the American Dietetics Association, Dr. Ottery said.